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NPI Code Detail

MEDICARE: DR. THERESA M KING D.C.

MEDICARE: DR. THERESA M KING D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor2850OR

General Provider Information

NPI Number : 1609852367
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA M KING D.C.
Provider Business Mailing Address
First Line : 4035 SE 52ND AVE
Second Line : SUITE B
City : PORTLAND
State : OR
Zip : 97206-3913
Country : US
Telephone Number : 503-774-4099
Fax Number : 503-774-0106
Provider Business Practice Location Address
First Line : 4035 SE 52ND AVE
Second Line : SUITE B
City : PORTLAND
State : OR
Zip : 97206-3913
Country : US
Telephone Number : 503-774-4099
Fax Number : 503-774-0106
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 04/04/2008

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